Study DesignA prospective consecutive cohort study (follow-up study).ObjectiveOur study investigated whether implantation of an expandable titanium mesh cage (Osseofix®) is a successful and safe minimally invasive therapy for osteoporotic vertebral compression fractures (VCF). Our experiences, clinical and radiological findings after 12 months follow-up are presented. Kypho- and vertebroplasty are well-established minimally invasive procedures for the treatment of osteoporotic VCF. The main complications associated with both procedures are uncontrolled bone cement leakage. Therefore a suitable alternative has been investigated.MethodsDuring June 2010 to May 2011 24 patients were included with 32 osteoporotic VCF (T6 to L4). All of them were stabilized with the Osseofix® system. Preinterventionally we performed X-ray, MRI, and bone density measurements (DXA). Clinical and radiological results were evaluated preop., postop. and after 12 months postop. based on the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS), X-ray (Beck Index, Cobb-angle) and CT.ResultsThere was a significant improvement in the mean ODI (70,6% to 30,1%) as well as a significant reduction in pain intensity (VAS) (7,7 to 1,4) after 12 month. The mean kyphotic angle according to Cobb showed significant improvements (11,7° to 10,4°) after 12 months. Postinterventional imaging showed only one case of loss of height in a stabilized vertebral body (3.1%). We saw no changes in posterior vertebral wall or adjacent fractures. Except for one pronounced postoperative hematoma we saw no surgical complications including no cement leakage.ConclusionsStabilization of symptomatic osteoporotic VCF with Osseofix® system is a safe and effective procedure, even in fractures with posterior wall involvement. The clinical mid-term results are good at a very low complication rate. The Osseofix® system is an interesting alternative to the established procedures of cement augmentation.

BackgroundDespite the known demographic shift with expected doubled rate of vertebral body fractures by the year 2050, a standardized treatment concept for traumatic and osteoporotic incomplete burst fracture of the truncal spine does not exist. This study aims to determine whether minimally invasive fracture care for incomplete osteoporotic thoracolumbar burst fractures using intravertebral expandable titanium mesh cages is a suitable procedure and may provide improved safety in terms of cement-associated complications in comparison to kyphoplasty procedure.MethodsIn 2011/2012, 15 patients (10 women, 5 men; mean age 77) with 15 incomplete osteoporotic thoracolumbar burst fractures (T10 to L4) were stabilized using intravertebral expandable titanium mesh cages (OsseoFix®) as part of a prospective study. X-ray, MRI and bone density measurements (DXA) were performed preinterventionally. The clinical and radiological results were evaluated preoperatively, postoperatively and after 12 months according to the visual analogue scale (VAS), the Oswestry Disability Index (ODI), X-ray (Beck Index, Cobb angle) and CT analyses. Wilcoxon rank sum test, sign test and Fischer’s exact test were used for statistical evaluation.ResultsA significant reduction in pain intensity (VAS) from preoperative 8.0 to 1.6 after 12 months and significant improvement in activity level (ODI) from preoperative 79.0 to 30.5 % after 12 months were revealed. Radiologically, the mean kyphotic angle according to Cobb showed significant improvements from preoperative 9.1° to 8.0° after 12 months. A vertebral body subsidence was revealed in only one case (6.7 %). No changes in the position of the posterior wall were revealed. No cement leakage or perioperative complications were seen.ConclusionAs a safe and effective procedure, the use of intravertebral expandable titanium mesh cages presents a valuable alternative to usual intravertebral stabilization procedures for incomplete osteoporotic burst fractures and bears the potential to reduce cement-associated complications.Trial registrationGerman Clinical Trials Register (DKRS) DRKS00008833.

Purpose: Determining whether implantation of an expandable titanium mesh cage (Osseofix? system) is a successful and safe minimally invasive therapy for osteoporotic and tumorous vertebral compression fractures (VCFs). Materials and Methods: 32 patients (25 women, 7 men, mean age 71) with 46 osteoporotic or tumorous VCFs (T6 to L4) from June 2010 to January 2012 were included. All of them were stabilized with the Osseofix? system. Preinterventionally we performed X-ray, MRI, and bone density measurements (DXA). The clinical and radiological results were evaluated preop, postop and 12 months postop based on the visual analog scale (VAS) and the Oswestry Disability Index (ODI), X-ray (Beck Index, Cobb angle) and CT. Results: There was a significant improvement in pain intensity (VAS) (7.8 to 1.6) as well as a?significant reduction in the mean ODI (71.36?% to 30.4?%) after 12 months. The mean kyphotic angle according to Cobb showed significant improvements (12.3? to 10.8?) after 12 months. Postinterventional imaging showed one case of loss of height in a stabilized lumbar vertebral body (2.2?%) in osteoporosis and one case with adjacent fracture (2.2?%) in osteoporosis. We saw no changes in the posterior vertebral wall. Except for one pronounced postoperative hematoma, we saw no surgical complications including no cement leakage. Conclusion: The clinical mid-term results are good at a low complication rate. The stabilization of symptomatic osteoporotic and tumorous VCFs with the Osseofix? system is a safe and effective procedure, even in fractures with posterior wall involvement. The Osseofix? system is an interesting alternative to the established procedures of cement augmentation. Key Points: ??The Osseofix? system is well suited for stabilizing osteoporotic and tumorous VCFs. ??It is a safe and effective procedure without cement leakage and with a low complication rate. ??The procedure is an interesting alternative to established cement augmentation procedures. Citation Format: ??Ender SA, Gradl G, Ender M et?al. Osseofix? System for Percutaneous Stabilization of Osteoporotic and Tumorous Vertebral Compression Fractures ? Clinical and Radiological Results After 12 Months. Fortschr R?ntgenstr 2014; 186: 380???387

Since 1984 we have done over the top repair of the acutely torn anterior cruciate ligament combined with augmentation by McIntosh lateral-substitution over the top procedure with iliotibial band in view of frequent instabilities following simple reconstruction. After treatment by continuous passive motion and early weight bearing is possible. The results at review were good. This method is recommended to avoid the risk of rerupture.

Despite therapeutic improvements in the treatment of arterial circulatory problems of the leg, several tens of thousands of amputations are performed every year. The amputation is not the end of the treatment but is the beginning of the rehabilitation. Decisive criteria for a successful rehabilitation are the quality of the leg-stump, the immediate and early care, and an adequate artificial leg.